WRITER: KATHLEEN SNODGRASS
CONTACT: BECKY SOGLIN
Iowa City IA 52242
(319) 335-6660; fax (319) 384-4638
Release: May 16, 2002
Care needed to avoid diabetes and pregnancy complications
While many people understand the dangers of diabetes, they usually underestimate
how it complicates a pregnancy. Diabetes is one of the leading causes of birth
defects in the United States. Complications of diabetes also include large
birth weight, excessive amounts of amniotic fluid, and preeclampsia (also
referred to as toxemia of pregnancy) which involves increased blood pressure,
headaches, protein in the urine and swelling in the lower extremities.
Diabetes is characterized by the body's inability to produce or use insulin.
Insulin regulates the amount of glucose (sugar) in the body. Type 1 diabetes
occurs when the body is unable to produce insulin, and Type 2 diabetes occurs
when the body is unable to use the insulin the body makes. University of Iowa
Health Care experts have developed many services to help patients decrease
risks and maintain healthy diabetes control. These services include the diabetes
and high-risk obstetrics clinics that provide preconception care.
Uncontrolled diabetes before conception and up to the first eight weeks
of pregnancy can cause major birth defects and spontaneous abortions. During
the second and third trimesters of pregnancy, uncontrolled glucose levels
can result in excessively large babies, creating risks to the mother and the
child. As a result, women with diabetes are more likely to have cesarean deliveries.
Despite these risks, women with diabetes are able to have successful and
healthy pregnancies. "It just takes a little work and commitment,"
said Vicki Kraus, Ph.D., a UI advanced registered nurse practitioner in internal
medicine and the obstetrics clinic. "Committing to a regimen and seeking
out support through physicians and nurses and from family members can lead
Stephen Hunter, M.D., Ph.D., a UI associate professor of obstetrics and
gynecology who specializes in high-risk pregnancies, stresses the importance
of preconception care in order to reduce risks.
"Not only does preconception care allow us to make sure the patient
has normal blood sugar levels, it also gives us a chance to look for other
conditions which may further complicate a pregnancy," Hunter said. "In
addition, preventive care allows us to educate the family. We use a team approach
that involves nurses, physician specialists, dietitians, psychologists and
social workers in order to optimize outcomes."
According to the National Institute of Diabetes and Digestive and Kidney
Diseases, 10 to 18 percent of non-pregnant woman ages 20 to 44 years have
some type of abnormal glucose tolerance that would be associated with fetal
or maternal risks if those women became pregnant.
Diabetes creates complicated and high-risk pregnancies. However, both Kraus
and Hunter emphasize that, with proper health care awareness, resources and
support, pregnancy is not something that has to be avoided.
For younger patients, diabetes is a special concern. Because this is the
age teenagers may experiment with sex and want as much self-control as possible
over their lives, diabetes often acts as a second parent, limiting the way
the teen can eat, exercise and act. Consequently, some teenagers with diabetes
do not have adequate regulation or control of the disease. As a result, pregnancies
in teens are further complicated. Health care providers stress the importance
of maintaining an insulin regimen and staying healthy.
Primary care physicians also play an integral role in the preventive process.
Routine preventive care stresses the importance of diabetes control and the
potential dangers of pregnancy, as primary care physicians inform patients
about risks and direct them to other resources, if needed.
"Physicians should routinely be asking female patients about their
diabetes and their plans regarding pregnancy. The patient should be informed
that blood sugar levels should be normal before conception," Kraus said.
As with all medical care, it is best to consult your personal physician
before making any changes to your health care routine.
If you have concerns about diabetes and pregnancy or would like more information,
call UI Health Access at (319) 384-8442 or toll-free at (800) 777-8442 and
ask to speak to the UI Intensive Insulin Therapy Clinic.
University of Iowa Health Care describes the partnership between
the UI Roy J. and Lucille A. Carver College of Medicine and the UI Hospitals
and Clinics and the patient care, medical education and research programs
and services they provide.